당뇨병환자의 관상동맥질환 중증도 평가지표로서의 상완발목동맥파속도의 유용성

Abstract

Background: Atherosclerosis is the underlying pathophysiology of coronary artery occlusive disease. As arterial stiffness reflects degree of systemic atherosclerosis and severity of peripheral artery occlusive disease, by measuring arterial stiffness, one can estimate severity of coronary artery occlusive disease in early stage. In this study we want to show the relationship of arterial stiffness and coronary artery occlusive disease, comparing in diabetes and non-diabetes group and decide the cutoff point of arterial stiffness to predict multivessel disease in diabetes group. Methods: Total 443 of 181 diabetes and 262 non-diabetes patients were enrolled in the study with informed consent. We performed percutaneous coronary angiography and measured AI, ABI, baPWV with a new device, noninvasive pulse wave analyzer. We also checked anthropometric, serologic data and demonstrated the extent of coronary artery occlusion by Gensini score. Results: There were significant differences in baPWV, Gensini score, pulse rate, pulse pressure, serum c-reactive protein (CRP), B-type natriuretic peptide (BNP) and fasting plasma glucose level, all higher in DM patient group. Gensini score was positively related to baPWV, fasting plasma sugar, serum CRP, BNP level and among these, baPWV was the independent predictor of multivessel disease (MVD) in both groups. Furthermore with ROC curve, we could set the cutoff value of baPWV at 1.635cm/sec to screen MVD with 64.6% sensitivity and 63.5% specificity. With this set point, odds ratio to develop MVD was 3.08 in the group above 1.635cm/sec compared to that below and DM patients showed higher sensitivity to this cutoff value. Conclusion: We suggest baPWV to be routinely checked in all diabetes patients to detect coronary artery occlusive disease and those who belong to the range above 1.635cm/sec should take prompt interventional measures to prevent further Complication.